Evaluation of patients receiving hemodialysis in an emergency service

Abstract

Aim: Acute kidney injury (ARH) is an important emergency with high mortality and morbidity depending on patient characteristics, comorbidity and clinical situation. Rapid recognition of acute renal failure (ARF) and initiation of renal replacement therapy (RRT) is one of the most important factors determining the survival of these patients. The initiation of RTT in the emergency department depends on the correct indications in the critical patient, the correct use of resources and effective nephrological follow-up. This study aims to determine the hemodialysis indications of patients undergoing hemodialysis for the first time in the emergency service and to investigate the effect of this application on routine hemodialysis and survival. Methods: We carried out a retrospective cohort study with patients who underwent hemodialysis for the first time by central venous catheterization in the emergency service between January 01, 2019 and December 31, 2019. Age, gender, presence of chronic disease, symptoms and laboratory values of the patients were recorded from the patient files in the hospital automation system. Data regarding the hospitalization or discharge of the patients after emergency hemodialysis were collected. Patient follow-up was carried out from the patient records, and the nephrology follow-ups were examined for 3 months after emergency hemodialysis. Their routine hemodialysis and 28-day mortality were evaluated. Results: A total of 185 patients were included in the study. 55.1% of the patients (n=102) were male and the mean age was 65.63 (15.92) years. While 49.2% (n=91) of the patients were included in the routine hemodialysis program, mortality developed in 22.7% (n=42) on the 28th day. No statistically significant relationship was found between the current systemic diseases, hemodialysis indications and undergoing routine hemodialysis program (P=0.327, P=0.45). Conclusion: Although there was no statistically significant relationship between the dialysis indications of the patients and their inclusion in the routine dialysis program, emergency hemodialysis is an important procedure. The clinical condition and laboratory values of the patients should be evaluated synchronously. Physicians should not be late in initiating hemodialysis in the follow-up and treatment of electrolyte disorders and intoxications; the treatment of the patient should be decided as quickly as possible.

Keywords

• Emergency Departments
• Dialysis
• Acute kidney injuries
• Hyperkalemia

Acil serviste hemodiyaliz alan hastaların değerlendirilmesi

Öz

Amaç: Akut renal hasar(ARH) hasta karakteristiklerine, komorbiditesine ve klinik durumuna bağlı olarak yüksek mortalite ve morbiditeye sahip önemli bir acildir Akut böbrek yetmezliğinin (ABY) hızla tanınıp, renal replasman tedavisinin (RRT) başlanması, bu hastaların hayatta kalımını belirleyen en önemli unsurlardan biridir. RTT’nin acil serviste başlanması ise kritik hastada doğru endikasyonların konulmasına, kaynakların doğru kullanımına ve nefrolojik takibin etkin şekilde sağlanmasna bağlıdır. Bu çalışmanın amacı acil serviste ilk kez hemodiyaliz alan hastaların hemodiyaliz endikasyonlarını belirlemek ve bu uygulamanın hastaların rutin hemodiyalize alınması ve sağ kalımları üzerine etkisini araştırmaktır. Yöntemler: 01 Ocak 2019- 31 Aralık 2019 tarihleri arasında acil serviste santral kateterizasyon işlemi yapılan ve hemodiyaliz uygulanan hastalar retrospektif olarak incelendi. Hastalara ait yaş, cinsiyet, kronik hastalık varlığı, acile geliş semptomları, laboratuvar değerleri hastane otomasyon sisteminde kayıtlı hasta dosyaları üzerinden kaydedildi. Hastaların acil hemodiyaliz sonrası hastaneye yatış ya da taburculuklarına ait veriler toplandı. Hasta kayıtlarından hasta takibi gerçekleştirilerek hastaların acil diyaliz alımı sonrası 3 aylık sürede nefroloji poliklinik takipleri incelenerek rutin hemodiyaliz programına alınımları ve 28 günlük mortaliteleri değerlendirildi. 18 yaş üzerinde olup acil serviste kateterizasyonu sağlanarak ilk diyalizi acilde serviste alan hastalar çalışmaya dahil edildi. Bulgular: Çalışmaya toplam 185 hasta dahil edildi. Hastaların %55,1‘i (n=102) erkek olup ortalama yaş 65,63 (15,92) olarak saptandı. Hastaların %49,2’ si (n=91) sonrasında rutin hemodiyaliz programına alınırken, %22,7’sinde ise (n=42) 28. günde mortalite geliştiği gözlendi. Hastaların mevcut sistemik hastalıkları ve hastaların diyalize alınma endikasyonları ile rutin hemodiyaliz programına alınması arasında da istatistiksel olarak anlamlı bir ilişki saptanmadı (P=0,327, P=0,45). Sonuç: Bu çalışmada her ne kadar hastaların diyalize alınma endikasyonları ile rutin diyaliz programına alınmaları arasında istatistiksel olarak anlamlı bir ilişki çıkmamasına rağmen acil hemodiyaliz önemli bir prosedürdür ve hastanın klinik tablosu ve laboratuvar değerleri eş zamanlı değerlendirilmelidir. Özellikle elektrolit bozuklukları ve intoksikasyonların takip ve tedavisinde hemodializ için geç kalınmamalı ve hastanın tedavisine hızla karar verilmelidir.

Anahtar Kelimeler

• Acil servis
• Diyaliz
• Akut böbrek hasarı
• Hiperkalemi

Kaynakça

1. 1. Challiner R, Ritchie JP, Fullwood C, Loughnan P, Hutchison AJ. Incidence and consequence of acute kidney injury in unselected emergency admissions to a large acute UK hospital trust. BMC nephrology. 2014;15:84. Epub 2014/06/03. doi: 10.1186/1471-2369-15-84. PubMed PMID: 24885247; PubMed Central PMCID: PMCPMC4046061.
2. 2. Kellum JA, Lameire N. Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (Part 1). Critical care (London, England). 2013;17(1):204. Epub 2013/02/12. doi: 10.1186/cc11454. PubMed PMID: 23394211; PubMed Central PMCID: PMCPMC4057151.
3. 3. Bouman CS, Oudemans-Van Straaten HM, Tijssen JG, Zandstra DF, Kesecioglu J. Effects of early high-volume continuous venovenous hemofiltration on survival and recovery of renal function in intensive care patients with acute renal failure: a prospective, randomized trial. Critical care medicine. 2002;30(10):2205-11. Epub 2002/10/24. doi: 10.1097/00003246-200210000-00005. PubMed PMID: 12394945.
4. 4. Sugahara S, Suzuki H. Early start on continuous hemodialysis therapy improves survival rate in patients with acute renal failure following coronary bypass surgery. Hemodialysis international International Symposium on Home Hemodialysis. 2004;8(4):320-5. Epub 2004/10/01. doi: 10.1111/j.1492-7535.2004.80404.x. PubMed PMID: 19379436.
5. 5. Wang X, Jie Yuan W. Timing of initiation of renal replacement therapy in acute kidney injury: a systematic review and meta-analysis. Renal failure. 2012;34(3):396-402. Epub 2012/01/21. doi: 10.3109/0886022x.2011.647371. PubMed PMID: 22260302.
6. 6. Ricci Z, Ronco C, D'Amico G, De Felice R, Rossi S, Bolgan I, et al. Practice patterns in the management of acute renal failure in the critically ill patient: an international survey. Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association. 2006;21(3):690-6. Epub 2005/12/06. doi: 10.1093/ndt/gfi296. PubMed PMID: 16326743.
7. 7. Bektas F, Nokay A, Güngör F, Söyüncü S. Demographic features of the patients with acute renal failure in the emergency department. Turk J Emerg Med. 2008;8(4):170-4.
8. 8. Liakoni E, Berger F, Klukowska-Rötzler J, Kupferschmidt H, Haschke M, Exadaktylos AK. Characteristics of emergency department presentations requiring consultation of the national Poisons Information Centre. Swiss medical weekly. 2019;149:w20164. Epub 2019/12/18. doi: 10.4414/smw.2019.20164. PubMed PMID: 31846508.

9. 9. Sidlak AM, Abesamis MG, Shulman JA, Marino RT. Feasibility of Intermittent Hemodialysis in Metformin Toxicity With Shock. The Journal of emergency medicine. 2020;58(5):749-55. Epub 2020/04/25. doi: 10.1016/j.jemermed.2020.02.018. PubMed PMID: 32327212.
10. 10. Co I, Gunnerson K. Emergency Department Management of Acute Kidney Injury, Electrolyte Abnormalities, and Renal Replacement Therapy in the Critically Ill. Emergency medicine clinics of North America. 2019;37(3):459-71. Epub 2019/07/03. doi: 10.1016/j.emc.2019.04.006. PubMed PMID: 31262415.
11. 11. Golestaneh L, Bellin E, Neugarten J, Lo Y. Avoidable visits to the emergency department(ED) and their association with sex, age and race in a cohort of low socio-economic status patients on hemodialysis in the Bronx. PloS one. 2018;13(8):e0202697. Epub 2018/08/25. doi: 10.1371/journal.pone.0202697. PubMed PMID: 30142175; PubMed Central PMCID: PMCPMC6108498.
12. 12. Rencuzogullari I, Çağdaş M, Karakoyun S, Karabağ Y, Yesin M, Gürsoy MO, et al. Association of Syntax Score II with Contrast-induced Nephropathy and Hemodialysis Requirement in Patients with ST Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention. Korean Circ J. 2018;48(1):59-70. Epub 2017/11/25. doi: 10.4070/kcj.2017.0058. PubMed PMID: 29171203; PubMed Central PMCID: PMCPMC5764871.
13. 13. Samuel D, Rafiu M, Akanbi O, Oluwamayowa D. Clinical and demographic characteristics of patients with kidney disease presenting at a tertiary hospital for expert care in south-west Nigeria. Journal of Surgery and Medicine. 2019;3(4):311-5. doi: 10.28982/josam.552956.
14. 14. Madala ND, Thusi GP, Assounga AG, Naicker S. Characteristics of South African patients presenting with kidney disease in rural KwaZulu-Natal: a cross sectional study. BMC nephrology. 2014;15:61. Epub 2014/04/16. doi: 10.1186/1471-2369-15-61. PubMed PMID: 24731300; PubMed Central PMCID: PMCPMC4003519.
15. 15. Vinson AJ, Bartolacci J, Goldstein J, Swain J, Clark D, Kiberd B, et al. Optimizing Ambulance Transport of Hemodialysis Patients to the Emergency Department: A Cohort Study. Canadian journal of kidney health and disease. 2019;6:2054358119848127. Epub 2019/06/28. doi: 10.1177/2054358119848127. PubMed PMID: 31245018; PubMed Central PMCID: PMCPMC6582295.
16. 16. Carl DE, Grossman C, Behnke M, Sessler CN, Gehr TW. Effect of timing of dialysis on mortality in critically ill, septic patients with acute renal failure. Hemodialysis international International Symposium on Home Hemodialysis. 2010;14(1):11-7. Epub 2010/04/10. doi: 10.1111/j.1542-4758.2009.00407.x. PubMed PMID: 20377649.
17. 17. García-Fernández N, Pérez-Valdivieso JR, Bes-Rastrollo M, Vives M, Lavilla J, Herreros J, et al. Timing of renal replacement therapy after cardiac surgery: a retrospective multicenter Spanish cohort study. Blood purification. 2011;32(2):104-11. Epub 2011/03/05. doi: 10.1159/000324195. PubMed PMID: 21372568.
18. 18. Iyem H, Tavli M, Akcicek F, Büket S. Importance of early dialysis for acute renal failure after an open-heart surgery. Hemodialysis international International Symposium on Home Hemodialysis. 2009;13(1):55-61. Epub 2009/02/13. doi: 10.1111/j.1542-4758.2009.00347.x. PubMed PMID: 19210279.
19. 19. Montford JR, Linas S. How Dangerous Is Hyperkalemia? Journal of the American Society of Nephrology: JASN. 2017;28(11):3155-65. Epub 2017/08/06. doi: 10.1681/asn.2016121344. PubMed PMID: 28778861; PubMed Central PMCID: PMCPMC5661285.
20. 20. Peacock WF, Rafique Z, Clark CL, Singer AJ, Turner S, Miller J, et al. Real World Evidence for Treatment of Hyperkalemia in the Emergency Department (REVEAL-ED): A Multicenter, Prospective, Observational Study. The Journal of emergency medicine. 2018;55(6):741-50. Epub 2018/11/06. doi: 10.1016/j.jemermed.2018.09.007. PubMed PMID: 30391144.
21. 21. Bajwa R, Amin A, Gandhi B, Mansur S, Amirpour A, Karawadia T, et al. A Simplified Approach to the Management of Hypercalcemia. The Open Urology & Nephrology Journal. 2018;11(1). doi: 10.2174/1874303X01811010022.
22. 22. Nishikawa M, Shimada N, Kanzaki M, Ikegami T, Fukuoka T, Fukushima M, et al. The characteristics of patients with hypermagnesemia who underwent emergency hemodialysis. Acute medicine & surgery. 2018;5(3):222-9. Epub 2018/07/11. doi: 10.1002/ams2.334. PubMed PMID: 29988705; PubMed Central PMCID: PMCPMC6028801.
23. 23. Oyamada N, Hamanaka I, Fujioka A, Iwasaku T, Minami T, Fujie H, et al. Effectiveness of high flow-volume intermittent hemodiafiltration during and after intervention to prevent contrast-induced nephropathy in patients with advanced chronic kidney disease: A pilot study. Catheterization and cardiovascular interventions: official journal of the Society for Cardiac Angiography & Interventions. 2019. Epub 2019/12/06. doi: 10.1002/ccd.28640. PubMed PMID: 31802610.
24. 24. Chibishev A, Petkovska L, Tozija L, Zdravkovska M, Shikole E. The role of hemodialysis in treatment of acute acetic acid poisonings. Int J Artif Organs. 2017;40(5):219-23. Epub 2017/05/13. doi: 10.5301/ijao.5000588. PubMed PMID: 28497450.